Duodenal ulcer (K26). Treatment of duodenum and stomach ulcers: main symptoms Types of stomach ulcers

1. According to etiology: 1) form associated with Helicobacter pylori; 2) form not associated with N.R.

2. By localization: secrete gastric ulcers and duodenal ulcers. Stomach ulcers: 1) cardiac and subcardial sections; 2) body of the stomach; 3) antrum; 4) pyloric region. Ulcers duodenum: 1) bulbs; 2) extra-bulbous section (extra-bulbous ulcers). There are also combined ulcers of the stomach and duodenum.

3. By type of ulcer: single and multiple.

4. According to the clinical course: 1) typical; 2) atypical (with atypical pain syndrome; painless, but with other clinical manifestations; asymptomatic).

5. According to the level of gastric secretion: 1) with increased secretion; 2) with normal secretion; 3) with reduced secretion.

6. According to the nature of the flow: 1) newly diagnosed peptic ulcer; 2) recurrent course: a) with rare exacerbations (once every 2-3 years or less); b) with annual exacerbations; c) with frequent exacerbations (2 times a year or more often).

7. According to the stage of the disease: 1) exacerbation; 2) remission.

8. According to the presence of complications: bleeding, perforation, stenosis, malignancy (degeneration into a cancerous tumor).

Etiology and pathogenesis. Main role in development peptic ulcer plays Helicobacter pylori (H.P.). As noted above, the disease is usually preceded by the development of chronic

Non-atrophic (Helicobacter) gastritis. Currently, it is believed that the formation of gastric or duodenal ulcers occurs as a result of changes that occur in the ratio of local factors of “aggression” and “defense”, while there is a significant increase in “aggression” against the background of a decrease in factors of “protection” " TO factors of "aggression" include: bacteria (N.R.); increased acidity and peptic activity of gastric juice in conditions of impaired motility of the stomach and duodenum; disturbances in the evacuation of food from the stomach, etc. Decreased activity "protective" factors due to: decreased production of mucobacterial secretion (the main components of the bicarbonate-mucosal barrier); slowing down the processes of physiological regeneration of the surface epithelium; decrease in blood circulation of the microcirculatory bed and nervous trophism of the mucous membrane; inhibition of the main mechanism of sanogenesis - immune system etc. “No acid - no ulcer!” - this provision can still be considered true for most cases of DU, although for DU this condition is not always necessary.

Clinical picture. It is characterized by great polymorphism and depends on the location of the ulcer, its size and depth, the secretory function of the stomach, and the age of the patient. The main syndrome is pain. They, as a rule, have a clear rhythm of occurrence, connection with food intake, and periodicity. In relation to the time elapsed after eating, it is customary to distinguish between early, late and “hunger” pain. Early pain appear 0.5-1 hour after eating, gradually increase in intensity, persist for 1.5-2 hours, decrease and disappear as gastric contents are evacuated into the duodenum. Such pain is characteristic of ulcers of the body of the stomach. When the cardiac, subcardial and fundal sections are affected, pain occurs immediately after eating. Late pain occur 1.5 - 2 hours after eating, gradually intensifying as the contents are evacuated from the stomach. They are characteristic of ulcers of the pyloric stomach and duodenal bulb. A combination of early and late pain is observed in patients with combined and multiple ulcers of the stomach and duodenum. "Hungry" (night) pain occur 2.5 - 4 hours after eating and disappear after the next meal. These pains are also characteristic of ulcers of the duodenum and pylorus of the stomach.

The severity of pain depends on the location of the ulcerative defect (minor - with ulcers of the body of the stomach, severe - with pyloric and extra-bulb ulcers), on age (more intense - in young people), and the presence of complications. The pain usually stops after taking antisecretory drugs.

Clinical course peptic ulcer disease can be complicated by bleeding, perforation of the ulcer in the (boring cavity, narrowing of the pylorus. With a long course, cancerous degeneration of the ulcer can occur. In 24 - 28% of patients, the ulcer can proceed atypically - without pain or with pain reminiscent of another disease (angina pectoris, osteochondrosis, etc.), and is discovered by chance. Peptic ulcer disease can also be accompanied by gastric and intestinal dyspepsia, asthenoneurotic syndrome.

Treatment. Patients with exacerbation of uncomplicated peptic ulcer disease are usually treated on an outpatient basis. The following categories of patients are subject to hospitalization: with newly diagnosed ulcer disease; with a complicated and often recurrent course; with severe pain that is not relieved by outpatient treatment; with peptic ulcer disease developing against the background of severe concomitant diseases.

For peptic ulcers, complex therapy is used, similar to the treatment of chronic gastritis: diet therapy, drug therapy, physiotherapy, spa treatment (in remission), exercise therapy. In the form not associated with N.R., all groups of antisecretory drugs are used.

A certain category of patients is exposed surgical course. The absolute indications for surgical liver surgery are the following complications: ulcer perforation; profuse gastrointestinal bleeding; stenosis, accompanied by severe evacuation disorders. Relative indications: repeated profuse gastrointestinal intestinal bleeding in the anamnesis; large callous penetrating ulcers, resistant to drug treatment.

IN complex treatment patients with peptic ulcer is used wide range non-medicinal agents that have a local and general effect on the body: hyperbaric oxygenation, laser therapy, balneotherapy, mud therapy, drinking mineral waters, physiotherapeutic procedures, therapeutic exercises in the gym and in the pool (with the selection of individual movement modes). However, all these means of treating peptic ulcer disease (including exercise therapy) have mainly an auxiliary, symptomatic effect on the body.

Prevention. To prevent exacerbations of peptic ulcer disease, two types of therapy are recommended, with patients observing general and motor regimens, as well as healthy image life.

1. Maintenance therapy(for several months and even years) with antisecretory drugs at half the dose. This type of therapy is used in the following cases: if it is ineffective antibacterial therapy; for complications of peptic ulcer; in patients over 60 years of age with an annually relapsing course of the disease.

2. Preventive therapy “on demand”. If symptoms of exacerbation of peptic ulcer disease appear, antisecretory drugs are used for 2 to 3 days. If symptoms disappear completely, therapy is stopped.

Very effective means Primary and secondary prevention of ulcer disease is sanatorium-resort treatment.

Forecast. In case of uncomplicated peptic ulcer - favorable. With effective antibacterial treatment, relapses during the first year occur in only 6-7% of patients. Early diagnosis and timely treatment using modern methods prevent the development of possible complications and preserve the ability of patients to work. The prognosis worsens when the disease is long-standing in combination with frequent, prolonged relapses, as well as with complicated forms of peptic ulcer disease - especially with malignant degeneration of the ulcer.

Test questions and assignments

1. Define chronic gastritis (CG). What is its prevalence?

2. Tell us about the classification of hCG and name the main etiological factors.

3. Describe the main pathogenetic mechanisms of chronic hepatitis.

4. Tell us about the clinical picture and course of this disease.

5. What are the main syndromes and symptoms of CG?

6. What gastric dysfunctions are observed with CG?

7. Tell us about the methods and means of treating chronic gastritis.

8. Define peptic ulcer (PU) of the stomach and duodenum.

9. Tell us about the classification of peptic ulcer and the main etio-1
logical factors.

10. What are the main mechanisms of pathogenesis of IB?

11. Describe clinical picture and the course of peptic ulcer disease.?

12. What types of pain are distinguished in this disease?

13. Transfer funds complex therapy in the treatment of peptic ulcer.

14. Tell us about the means of prevention and prognosis of this disease.

Localization. According to Johnson's classification, there are three types of gastric ulcers: I

type - mediogastric ulcer is located in the body of the stomach; Type II --

combined peptic ulcer of the stomach and duodenum; III type --

prepyloric ulcers and ulcers of the pyloric canal.

The acidity of the gastric contents correlates with the location of the ulcer in the stomach.

gastric juice.

Mediogastric ulcer occurs 4 times less often than duodenal ulcer,

mainly in people over 40 years of age. Accounts for 57% of all gastric ulcers.

Pathogenesis. The etiological factors are duodeno-gastric reflux, stasis

in the antrum, damage to the mucosal barrier. Sometimes they matter

factors such as rough food, alcohol, smoking.

In the development of a mediogastric ulcer, the predominant role is played by

weakening of the protective mechanisms of the gastric mucosa against the action

acid-peptic factor. The occurrence of a mediogastric ulcer is preceded by

For the most part, the symptom complex inherent in normohypersecretory chronic

gastritis. A feature of chronic gastritis is antrocardial

spread of the process characterized by pylorization of the gastric (main)

iron At the junction of those who have retained specific secretory activity and those who have lost

its areas of the mucous membrane create conditions for the most intense

acid-peptic effects. Distally it weakens as a result

binding and neutralization of hydrochloric acid by the alkaline secretion released here

antral glands.

Duodenogastric reflux is one of the causes of chronic

antral gastritis and gastric ulcers. Under physiological conditions, the antral

department and the pyloric sphincter prevent the reflux of duodenal contents into

stomach. The mechanism of development of duodenogastric reflux is associated with a violation

antroduodenal motility. In case of insufficiency of the pyloric sphincter

an excess amount of duodenal contents enters the stomach. Long

contact of bile and pancreatic juice with the gastric mucosa leads to

development of gastric changes in the mucous membrane with intestinal metaplasia

epithelium. Bile releases gastrin and histamine from the mucous membrane, which

stimulate the secretion of hydrochloric acid and pepsin.

The harmful effect of bile on the gastric mucosa is due to the fact that

bile washes away mucus from the surface of the mucous membrane, causes cytolysis of cells

epithelium. As a result, the protective barrier of the mucous membrane breaks through and

the reverse diffusion of H+ ions into the mucous membrane increases. Due to

increased intake of H+ ions into the mucous membrane, its buffer is depleted

system and tissue acidosis occurs. As a result of a decrease in pH and action

histamine increases capillary permeability, swelling and hemorrhages occur in

mucous membrane, which makes it more susceptible to the action of ulcerogenic

factors present in the stomach cavity.

Disodecithin (an intermediate

product of fat digestion) is a highly toxic substance for cell membranes.

The reason for the decrease in mucosal resistance and regenerative capacity

it may be a circulatory disorder. This factor becomes important in

older age groups with so-called senile ulcers, the development of which

are associated with atherosclerosis of the gastric arteries.

Schematically, the pathogenesis of a mediogastric ulcer can be represented as follows:

way: duodenogastric reflux - chronic antral gastritis - decrease

resistance of the gastric mucosa to acid-peptic effects

Features of the pathogenesis of mediogastric ulcers in contrast to the pathogenesis of ulcers

duodenum is that with a stomach ulcer, acidity is often below normal and

significantly lower than in patients with duodenal ulcer.

The hypacid state of gastric contents with a mediogastric ulcer can

be associated with a decrease in the mass of parietal cells and with a decrease in their

functional activity, increased by reverse diffusion of H+ ions.

Clinic, diagnosis: mediogastric ulcer begins more often in people over 40

years. The main symptom of the disease is pancreatic pain in the epigastric region.

Pain occurs immediately after eating or after 15-45 minutes. The closer to the cardia

the location of the ulcer, the shorter the period after eating, pain occurs.

Duration of pain is 1-1 1/2 hours. Pain stops after eating

evacuated from the stomach. Pain occurs depending on the nature and amount

food eaten. Initially, the pain appears following errors in the diet, then

after a large meal and finally after every meal.

The pain is localized between the xiphoid process and the navel, often slightly to the left

midline, radiates beyond the sternum, into left half chest, in the back.

The intensity of the pain varies, aching, pressing pain, as with gastritis, or

quite intense, forcing the patient to take a half-bent position,

press down on the abdominal wall with your hand.

The daily rhythm of pain is observed, but not naturally: food - rest - pain -

relief, etc. Loss of the circadian rhythm of pain appears to be associated with the presence

gastritis. With perivisceritis, the pain becomes constant, the area

irradiation becomes extensive.

Heartburn and sour belching often occur. Occasionally at the height of pain comes

vomit. Vomit contains an admixture of recently eaten food. After vomiting pain

pass. Patients artificially induce vomiting to relieve pain.

Palpation of the abdomen reveals diffuse pain in the epigastric region,

percussion zone of pain to the left of the midline, and with cardiac ulcers -

at the xiphoid process. Local tension in the abdominal wall muscles is usually not

is revealed.

It is very important that benign and malignant

stomach ulcerations may have the same symptoms.

X-ray examination. A direct radiological sign of an ulcer is a “niche”

against the background of the stomach wall in the form of a crater filled with barium or a “relief niche” in

the form of a barium spot. Folds converge to the location of the “niche”

mucous membrane. X-ray examination reveals various

deformations of the stomach as a result of cicatricial processes: double-cavity stomach (so

called hourglass), "snail-shaped deformation" due to massive

scarring of an ulcer of lesser curvature in the longitudinal and transverse directions, ascadal

stomach with a peculiar direction of scarring of the ulcer back wall stomach.

Endoscopic examination is of decisive importance in the diagnosis of chronic gastric ulcers.

a study with a biopsy, a nutritional study of the biopsy gives an accurate

diagnosis in 95%, cytological examination in 70% of cases. However, it is possible

false negative results (5-10%), when the lesion is malignant, and the data

Histological examination of the biopsy specimen does not reveal it. This is why patients with

chronic gastric ulcers require systematic follow-up

with X-ray and endoscopic examination of the stomach with mandatory

gastro-biopsy.

Exacerbations of the disease with stomach ulcers usually do not have a seasonal pattern,

periods of remission are short.

Treatment: permanent healing of gastric ulcers with conservative measures is observed

quite rare. Relapse of the disease and various complications occur in 75-80%

Surgical treatment is indicated for patients: a) with a benign ulcer, which

does not scar, despite complex conservative treatment V

for 8 weeks; b) elderly people with reduced secretory function of the stomach,

especially in the presence of relapses and complications in the anamnesis; c) with chronic

recurrent ulcer in the antrum of the stomach; d) if you suspect

malignancy of the ulcer.

The choice of surgical method is determined by the characteristics of this localization of the ulcer.

(atrophic changes in the mucous membrane, normal or even decreased

production of hydrochloric acid, the possibility of cancerous transformation). Distal

resection of half the stomach with removal of the antrum and excision of the ulcer with

gastroduodenoanastomosis according to Billroth-I is the most common method

If the surgeon is not absolutely sure that the ulcer is benign

with careful inspection during surgery, 3/4 resection is indicated

stomach with simultaneous removal of the corresponding sections of the omentum and

regional lymph nodes.

Combined peptic ulcer of the stomach and duodenum. Most often

first a duodenal ulcer appears and after a few

years - gastric ulcer (in 93% of patients). Level of acid production

pathogenetically and clinically, combined ulcers are similar

duodenal With a duodenal ulcer complicated by stenosis, the ulcer in

stomach develops in 6-18% of patients. Hypertrophy was detected in combined ulcers

fundic glands, atrophy and enterolization of the pyloric glands. This is

cause of high acid production and decreased acid-neutralizing function

antral-pyloric region.

Pathogenesis: theory of antral stasis. Peptic ulcer occurs first

duodenum, the ulcer causes narrowing when scarring

duodenum. In this regard, evacuation from the stomach is disrupted.

Long-term stasis of food in the antrum, increased peristalsis

promote the release of gastrin and increased secretion of hydrochloric acid. Buffer

the properties of food are depleted and the contents of the stomach become sour. Happening

damage to the mucous membrane by the acid-peptic factor and ulceration.

In the development of ulcers in the stomach in the presence of ulcers in the duodenum, takes

reflux involved. duodenal contents into the stomach. Motor impairment

duodenum and antral-pyloric region is the cause

duodeno-gastric reflux. Excessive amount of duodenal contents

in the stomach causes the development of gastritis, spreading towards

cardia. A stomach ulcer is located in the area affected by gastritis on the border with

acid-producing mucous membrane.

The course of combined ulcers is more severe compared to duodenal ulcers

intestines and with stomach ulcers.

Clinical course: two periods - in the first period signs of an ulcer appear

duodenum, and then when a stomach ulcer occurs, symptoms

changes Pain syndrome is pronounced, persists for a long time, lengthens

period of exacerbation, ulcers slowly scar, there is no periodicity and

seasonality of exacerbation, complications often occur (in 60% of patients)

If by the time of the examination the duodenal ulcer has healed, and

there is only a stomach ulcer; palpation of the abdomen causes pain in

epigastric region, most pronounced to the left of the midline of the abdomen.

Diffuse pain on palpation of the epigastric region occurs when

exacerbation of ulcers of both localizations, i.e. in the duodenum and stomach.

Difficulties in X-ray diagnostics are due to the inability to exclude

Stomach ulcer is called deep damage to the mucous membrane, sometimes submucosal membrane of the stomach, resulting from inflammation, which is caused by irritating factors: pepsin, acid, bile.

The prevalence is about 10% among the total population; asthenics get sick more often, mainly men.

It occurs in the form of periodic seasonal exacerbations followed by remissions. After the ulcer heals, a scar always forms, in contrast to ordinary superficial erosion.

The following types of stomach ulcers are distinguished:

Ulcers that occur when there is an imbalance of hormonal mechanisms with the central nervous system;
- hypoxic-circulatory lesions;
- endocrine;
- toxic-allergic damage to the gastric mucosa;
- specific (for certain diseases);
- medicinal.

Causes of stomach ulcers.

1. Infection with Helicobacter microbes, which feel very comfortable in the acidic environment of the stomach, although previously it was believed that it was impossible to survive in such an environment.

2. Systemic use of anti-inflammatory drugs non-steroidal drugs(ibuprofen, indomethacin, aspirin, naclofen, nemesil and others), pancreatic diseases, hormonal imbalances.

3. Impaired blood supply to the stomach, gastritis.

4. Genetic determination, congenital antitrypsin deficiency, metabolic features.

5. Serious errors in nutrition: unsystematic, dry food, semi-finished products, concentrates, spices, smoked foods, soda, peppery, salty, fried, sour, spicy, chemically, mechanically and thermally irritating foods, especially hot ones, causing permanent burns in the stomach.

6. Psychogenic factors (depression, stress, anxiety, overwork, systemic lack of sleep).

7. Alcohol addiction, nicotine.

8. Caffeine abuse.

9. Tumor processes in the body: sarcoma, leiomyoma, adenocarcinoma, carcinoid.

10. Foreign bodies, syphilis, Crohn's disease, tuberculosis, diabetes, HIV.

The function of the stomach depends on the ratio of protective factors (mucus) and aggression (hydrochloric acid, pepsin, possibly Helicobacter). When the latter prevails, the pathological process starts, leading to peptic ulcer disease.

Symptoms and signs of stomach ulcers:

Severe pain in the epigastrium (in the very upper part of the abdomen, under the xiphoid process of the sternum). Time of occurrence: on an empty stomach, 1.5-2 hours after eating, at night. Weakening: immediately after eating, taking acid-reducing medications;

Dyspeptic manifestations (digestive disorders): nausea, heartburn, vomiting with an acidic taste, belching. Very often, patients voluntarily induce vomiting, which brings relief. Therefore, they lose weight, appetite and are constantly pale;

Signs of the disease also depend on the person’s individual perception, pain threshold, duration, size and location of damage to the gastric mucosa.

Diagnosis of stomach ulcers.

Collecting anamnesis from the patient (when pain appears, what it is like, how it is relieved, etc.);

General clinical tests ( general analysis urine, blood, to identify concomitant pathology, or signs of hidden bleeding in the form of anemia);

Fibrogastroscopy is the most reliable and only way, excluding surgery, to see the location of the ulcer, its size, depth and shape. A fibrogastroscope is a thin bendable tube, at the end of which there is a light and a camera that allows you to see everything on the monitor. The method allows you to exclude an oncological process.

Targeted biopsy - taking a piece of tissue from the bottom and edges of the ulcer with a special instrument. The biopsy is sent for histo-examination, which can reveal the probable oncological cause of the damage (cancerous variant of peptic ulcer);

Laboratory tests of stomach contents for Helicobacter microbes. The material is collected using an endoscope;

Fecal occult blood test;

Analysis of gastric function for acid formation using pH-metry;

X-ray examination with barium contrast. In this case, a “niche” is visible on the relief, the contour of the gastric mucosa, which is an indirect sign of the disease;

Antroduodenal manometry, electrogastroenterography to determine gastrointestinal motility disorders.

Treatment of stomach ulcers.

1. Omez (or other proton pump inhibitors, reduce the secretion of hydrochloric acid) + bismuth (envelops the mucous membrane) + antibacterial drugs(clarithromycin and amoxicillin or metronidazole to kill Helicobacter bacteria). This treatment is called three-component or quadritherapy.

At the same time appointed medicines, reducing stomach acidity (bicarbonates). These also include baking soda, which patients often drink for heartburn. The duration of taking the drugs is from 7 to 14 days.

2. Diet (table No. 1, 1a), which consists of sparing the stomach by reducing the volume of food, increasing the frequency (at least 6 times), eliminating thermal, chemical and mechanical irritants. Everything needs to be boiled or steamed.
The consistency should be semi-liquid, mushy, or liquid. Temperature gradient 15°C - 50°C. The calorie content of food is reduced by carbohydrates. To stop exacerbations of the disease, it is recommended to turn the diet into a way of life and eat this way constantly.

3. Surgical: if conservative treatment is ineffective within 2 months, or in case of complications (profuse bleeding, perforation of the gastric wall, suspicion of an ulcer turning into cancer, narrowing of the pylorus, sometimes callous ulcers that do not scar and quickly transform into a tumor) + postoperative physiotherapy and balneology techniques. Options surgical treatment: removal of the stomach (resection) and organ-preserving surgery. The purpose of resection: reducing acidity, eliminating the ulcer as a cause of complication. Laparoscopic removal of the stomach is possible.

There is still no generally accepted medical classification of peptic ulcer disease. This is due to the lack of research and knowledge of the exact causes of its occurrence. There are many classifications compiled on different continents, but none of them is based entirely on knowledge of the etiology, course and pathogenesis of the disease.

What kind of disease is this?

Peptic ulcer - chronic illness mucous membrane of the stomach or duodenum, in which, under the influence of bile, hydrochloric acid and the enzyme pepsin, trophic disorders - ulcers - appear on the mucous membrane. The disease is characterized by the ability to recur: periodically the ulcer worsens, and then goes into a weakening phase and chronic course. The disease often develops due to gastritis or inflammation of the duodenal mucosa, poor diet, smoking and hereditary predisposition. In almost 50% of cases it occurs due to stress. It is important to heal the disease well, otherwise what will form is not a small scar, but a cicatricial-ulcerative deformation that closes the lumen of the stomach, preventing food masses from passing further into the intestines. This deforming form of ulcer appears more often in the duodenum.

Types of peptic ulcer

Based on the location, flow, origin and size of the formations were created various classifications ulcers They are still used to this day as the main ones when making a diagnosis, when it is necessary to determine the type of pathology. Accurate diagnosis helps prescribe effective treatment.

Types of ulcers by location

According to localization pathological process allocate the following types:

• stomach ulcer (in the pylorus, lesser and greater curvature, antrum, stomach walls);
• duodenal ulcer (extra-bulbous and bulbous, postbulbar);
• peptic ulcer of the stomach and intestines;
• peptic ulcers of the esophagus and small intestine.

In medical cards, gastric ulcer is abbreviated as peptic ulcer, and duodenal ulcer is abbreviated as peptic ulcer.

Types of pathology by course

Acute and chronic ulcers are just forms of manifestation of pathology. Each of them can occur in one of several forms, differing in the number of relapses per year. The disease, which passes in a latent form, does not manifest itself in any way. In mild cases, relapse occurs at intervals of several years. A moderate degree of damage occurs 1-2 times a year, and a severe form occurs three times or more, with nearby organs suffering.

Types of pathology by origin

In the classification, pathologies are distributed depending on the causes of their occurrence and are otherwise called symptomatic. These include the following:

• medicinal;
• stressful;
• discirculatory-hypoxic, arising from diseases of internal organs;
• endocrine.

Types of pathology by size

The classification includes the separate distribution of gastric and intestinal ulcers. Depending on the size of the neoplasms, the following are distinguished.

Today, peptic ulcers are getting in the way of more and more people, and the issue of their treatment is even more pressing. But the main factor in successfully curing an illness is the correct identification of the type of illness. Therefore, the topic of this article is types of ulcers. And also which species are dangerous to life.

In the most general concept, an ulcer is a scar that is purulent or inflammatory in nature, and is located on skin or mucous membrane.

In the case of the stomach, an ulcer is a disease that is chronic in nature, affecting the mucous walls of the stomach.

Breakdown of the disease according to general characteristics

Medicine has come a long way in its development and has studied peptic ulcers quite deeply. At the moment, there are many classifications of this disease.

They have such varieties as:

• stressful (causes bleeding from the site of the ulcer and occurs against the background of difficult experiences);
• medicinal (damage to the stomach due to drugs harmful to health);
• endocrine (caused by calcium and phosphorus deficiency).

Separation of peptic ulcers by localization of inflammatory processes

In the most general approach, two types of ulcers can be distinguished by location. These are external, located on the body, which can be identified visually, and internal, which is found in the stomach or duodenum. A more detailed distribution of internal ulcers into subtypes is as follows:

• intestinal defect localized in the area of ​​the bulb. As well as damage to the intestinal tract in the area followed by the duodenum;
• destruction of various gastric areas;
• combined - an ulcer of the stomach and duodenum, which is simultaneously located in several places.

Grouping of ulcers depending on the nature of their manifestation:

• The acute form is the formation of an ulcerative defect in the gastric zone, which forms within a short time. This gastric ulcer is usually diagnosed in young men.
• An uncomplicated gastric ulcer is a disease that does not pose a threat to human life, but also reduces performance. If treatment is ignored, this form of the disease can develop into an aggravated pathology.
• Acute peptic ulcer disease - has symptoms such as: stomach or intestinal bleeding, nausea, heartburn, severe pain and tingling in the area of ​​the right rib. Requires immediate medical attention.
• Penetrating ulcerative form - the ulcer enters the tissues and organs that are nearby. The first stage is when the ulcer affects all layers that make up the organ. The second is the connection with the underlying tissues. And the last one is the penetration stage, which is at the final stage.
• Gastric pyloric stenosis is a disease that impairs the passage of food into the stomach and intestines, and also makes the lumen of the digestive tract narrower.

Subdivision based on size, defects formed

The classification of peptic ulcer disease by size factor is as follows:

• small in diameter (up to 50 mm);
• medium (from 50 to 200 mm);
• large in size (200–300 mm);
• giant (from 300 mm and more).

Differences in the activity of the stomach and duodenum during illness

The concept of an ulcer is similar in essence to the term wound, but the defect of an ulcer deeply affects the stomach and duodenum, disrupting their performance. A peptic ulcer heals only with the formation of a scar, unlike a wound. There are a number of ulcers, each of which leads to different consequences:

• Increased acid content in gastric juice. This is indicated by a burning sensation in the esophagus, loss of appetite, irritability and other symptoms.
• Reducing acid concentration. Causes the appearance of fermentation processes in the stomach, bad breath, and a large number of gases in the intestines.
• Increased speed of movement of the intestinal wall and transportation of contents through it.
• Slow intestinal motility.

Other varieties

The ulcer is also characterized by the individual sensitivity of the patient. Having identified certain pain and symptoms, it is necessary to contact a specialist, since some types of ulcers are unsafe for human life.

Perforated gastric ulcer – dangerous complication which occurs when a deep hole forms in the wall of the esophagus. The abdominal cavity becomes significantly inflamed. This disease is dangerous due to the possibility of the ulcer breaking out beyond the stomach into abdominal cavity and is accompanied by the release of content.

The main symptoms are severe pain in the abdominal area coupled with a simultaneous fall blood pressure and then vomiting. It occurs due to a general infection of the body by pathogenic microbes that have entered the blood.

The callous variety, as a rule, does not cause scars for a long time and is unusually dangerous for humans, since it causes stomach cancer. It is characterized by constant pain, increased gastric secretion, nausea and vomiting, weight loss, slower metabolic processes, and pallor.

Without surgical intervention in case of callous ulcer it is indispensable. If you do not resort to it, then best case scenario It will only be possible to eliminate the symptoms for a short period of time. A callous ulcer is a continuation of an acute one.

Mirror view – inflammatory process touches the mucous membrane and causes a depression that includes several layers of the digestive canal. In this case, there are no symptoms and there are two sources of damage, located one above the other. At the same time, the right and left walls of the muscle sac are inflamed, which is very risky for life.

Chronic type - transition from an acute form, if long time no scars appear chronic form quite difficult to identify. This is only possible with systematic examinations by a doctor.

At functional disorders digestion, nausea, intense abdominal pain, bad breath and heartburn, think about the possible occurrence chronic type ulcers

Stomach ulcers caused by various diseases

The most diverse types of ulcers receive permanent residence in the human body as a result of these pathologies:

• loss of the kidneys' ability to produce and excrete urine, which leads to secondary damage to all body systems;
• death of liver tissue, which causes scar tissue nodules, and changes in its structure;
• viral inflammatory liver lesions;
• pancreatic diseases, high blood pressure and narrowing of the arteries.

We must not forget about these ailments, which are the cause of ulcers. If they are diagnosed in a timely manner and measures are taken, then treatment various types peptic ulcer disease will not be useful.

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